2023 HESI Advanced Pathophysiolog Y Fnp V1 100 Practice Questions And Answers
2022 - 2023 HESI
Advanced
Pathophysiolog FNP
(Ver. 1 ) 100
Practice Q and A
Included
1. According to Walter B. Cannon, homeostasis is a stable
internal environment achieved through a system of:
A) Interdependentsystem-wide adaptive responses
B) Variable internal and external conditioning factors
C) Coordinated physiologic processes that oppose change
D) Compatibility between cells and the internal environment
Ans: C
Feedback:
Walter B. Cannon identified homeostasis, achieved by a
coordinated physiologic processthat opposes change. Claude Bernard
recognized the importance of compatibility between cells and the
internal environment. Hans Selye identified the general (systemic)
adaptive and interdependent responses to stress. According to Selye,
stressors produce different responses due to the influence of adaptive
internal or external factors (conditioning factors).
2. A child has been experiencing hypoglycemic episodes. “How
does the body know when to secrete insulin and when to stop
secreting it?” The best response by the nurse, explaining the
physiologic background, would be:
A) “The body knows that if the blood glucose level falls, it will
inhibit insulin secretion and release glycogen to release glucose from
the liver.”
B) “It'sjust a big guessing game; first we give sugar like orange
juice, and then we withhold the carbohydrates if the blood glucose
level is too high.”
C) “Your pituitary gland in the brain is the 'master gland,' and it
controls and regulates all the hormones.”
D) “Once the child starts getting confused, the brain will send a
message to the pancreas to stop producing insulin.”
Ans: A
Feedback:
In the negative feedback mechanism that controls blood
glucose levels, an increase in blood glucose stimulates an increase in
insulin, which enhances removal of glucose from the blood. When
glucose has been taken up by cells and blood glucose levels fall, insulin
secretion is inhibited and glucagon and other counterregulatory
mechanisms stimulate release of glucose from the liver, which causes
blood glucose levels to return to normal.
3. A client presents to the emergency department following a
major traffic accident. Though outwardly there are no apparent
physical injuries found, the client is experiencing chest pain and
heightened alertness, which the health care worker attributes to the
first stage of general adaptation syndrome (GAS). The health care
worker concludesthe client is experiencing manifestationsrelated to
the release of:
A) Aldosterone, which interferes with sodium absorption
B) Epinephrine
C) Too little cortisol
D) Thyroid-stimulating hormone
.
Ans: B
Feedback:
The general adaptation syndromes hasthree stages—the first
is alarm (fight or flight); second is resistance (fight); and the third is
exhaustion. The alarm stage is characterized by a generalized
stimulation of the sympathetic nervous system (SNS) and the HPA,
resulting in release of catecholamines and cortisol. Increased insulin
release or TSH release is not part of the GAS.
4. Although stress exposure initiates integrated responses by
multiple systems, the functional results are first manifested as: Select
all that apply.
A) Enhanced respiratory rate/depth
B) Cravingsfor high-carbohydrate foods
C) Increased alertness and focus
D) Increased glucose utilization
E) Increased GI peristalsis
Ans: A, C, D
Feedback:
Exposure to stress activates an immediate response by the
neuroendocrine system that plays a role in most of the responses to
stress and attempts to adapt. Results of the coordinated release of
these neurohormones include mobilization of energy, a sharpened
focus and awareness, increased cerebral blood flow and glucose
utilization, enhanced cardiovascular and respiratory functioning,
redistribution of blood flow to the brain and muscles, modulation of
the immune response, inhibition of reproductive function, and a
decrease in appetite.
5. A client is experiencing significantstress while awaiting the
results of her recent lymph node biopsy. Among the hormonal
contributors to this response is a release of aldosterone, resulting in
which of the following physiologic effects?
A) Decreased release of insulin
B) Increased cardiac contractility
C) Potentiating effects of epinephrine
D) Increased sodium absorption
Ans: D
Feedback:
Mineralocorticoidssuch as aldosterone increase sodium
absorption by the kidneys. Changes in insulin release and cardiac
contractility are mediated by catecholamines, whereas cortisol
potentiates the action of epinephrine.
6. While looking at cancer cells under a microscope, the
instructor asks the students to describe the cells. Which of the student
answers are accurate? Select all that apply.
A) The cells are in different sizes and shapes.
B) The nucleoli are larger than normal.
C) The cells are contact inhibited.
D) The cells do not resemble the tissue of origin.
E) The cells are attached to an extracellular matrix.
Ans: A, B, D
Feedback:
Undifferentiated cancer cells are marked by a number of
morphologic changes. Both the cells and nuclei display variations in
size and shape. Their nuclei are variable in size and bizarre in shape,
their chromatin is coarse and clumped, and their nucleoli are often
considerably larger than normal. The cells of malignant tumors are
characterized by wide changes of parenchymal cell differentiation from
well differentiated to completely undifferentiated. Normal cells that
are grown in culture tend to display a feature called cell density–
dependent inhibition, in which they stop dividing after the cell
population reaches a particular density. This is sometimes referred to
as contact inhibition since cells often stop growing when they come
into contact with each other. In contrast to normal cells, cancer cells
often survive in microenvironments different from those of the normal
cells. They frequently remain viable and multiply without normal
attachments to other cells and the extracellular matrix.
7. The angiogenesis process, which allows tumorsto develop
new blood vessels, is triggered and regulated by tumor-secreted:
A) Procoagulants
B) Growth factors
C) Attachmentfactors
D) Proteolytic enzymes
Ans: B
Feedback:
Many tumors secrete growth factors, which trigger and
regulate the angiogenesis process. Tumor cells express various cell
surface attachment factors, for anchoring. Tumor cells secrete
proteolytic enzymes to degrade the basement membrane and migrate
into surrounding tissue. Cancer cells may produce procoagulant
materials that affect clotting mechanisms.
8. Which of the following processes characterizes an epigenetic
contribution to oncogenesis?
A) A DNA repair mechanism is disrupted.
B) A tumor suppressor gene is present, but it is not expressed.
C) Cellslose their normal contact inhibition.
D) Regulation of apoptosis in impaired, resulting in
accumulation of cancer cells.
Ans: B
Feedback:
Epigenetic mechanisms of cancer growth involve changes in
the patterns of gene expression without a change in the DNA.
Epigenetic mechanisms may “silence” genes,such astumorsuppressor
genes, so that even though the gene is present, it is not expressed and
a cancer-suppressing protein is not made. Disruption of DNA repair
may contribute to cancer, but this process is not particular to
epigenetics. Similarly, loss of contact inhibition and impaired apoptosis
are associated with cancer but are not specific manifestations of
epigenetic mechanisms.
9. An oncology nurse is caring for a client with newly diagnosed
B-cell lymphoma. Extensive blood work has been drawn and sent to
the lab. Results reveal an elevated antiapoptotic protein BCL-2 level.
The client/family asks, “What does this mean?” The health care
provider bases his or her response on the fact that:
A) The client's immune system is trying to kill the cancer cell by
sending this protein to engulf it.
B) This is a good result. Normal cells undergo apoptosis if DNA
is damaged in any way.
C) This means the cancer cells have found a way to survive and
grow even with damaged DNA.
D) The client's body istrying to limit the blood supply to the
cancer cells by producing high levels of this protein.
Ans: C
Feedback:
Alterations in apoptotic and antiapoptotic pathways have
been found in many cancers. One example is the high levels of the
antiapoptotic protein BCL-2 that occur secondary to a chromosomal
translocation in certain B-cell lymphomas. The mitochondrial
membrane is a key regulator of the balance between cell death and
survival. Proteinsin the BCL-2 family reside in the inner mitochondrial
membrane and are either proapoptotic or antiapoptotic. Since
apoptosis is considered a normal cellular response to DNA damage,
loss of normal apoptotic pathways may contribute to cancer by
enabling DNA-damaged cells to survive.
10. A farmer's long-term exposure to pesticides has made the
cellsin his alveoli and bronchial tree susceptible to malignancy. Which
of the following processes has taken place in the farmer's lungs?
A) Promotion
B) Progression
C) Initiation
D) Differentiation
Ans: C
Feedback:
Initiation involvesthe exposure of cellsto appropriate doses
of a carcinogenic agent that makes them susceptible to malignant
transformation, whereas promotion involves the induction of
unregulated accelerated growth in already initiated cells. Progression
isthe later process whereby tumor cells acquire malignant phenotypic
changes, and differentiation is the process of specialization whereby
new cells acquire the structural, microscopic, and functional
characteristics of the cells they replace.
11. Which of the following practitionersis most likely to be of
immediate assistance in the first 24 hours following delivery of an
infant with a cleft lip?
A) Lactation consultant
B) Respiratory therapist
C) Occupational therapist
D) Social worker
Ans: A
Feedback:
Infants with a cleft lip typically have difficulty with feeding,
and the assistance of a lactation consultant may be of help in
establishing feeding patterns. Oxygenation is not a typical problem,
while activities of daily living and assistive devices are not relevant
considerations. While social work is often of assistance when a child is
born with a congenital condition, a cleft lip has fewer implications than
most other inherited disorders.
12. The newborn has been born with distinctive physical features
of trisomy 21, Down syndrome. The mother asks the nurse, “What is
wrong? My baby looks different than his brother.” The nurse assesses
the infant and notes which of the following characteristics that
correlate with trisomy 21? Select all that apply.
A) Upward slanting of eyes
B) Large, protruding ears
C) Large tongue sticking out the mouth
D) Long fingers with extra creases
E) Flat facial profile
Ans: A, C, E
Feedback:
The physical features of a child with Down syndrome are
distinctive, and therefore the condition usually is apparent at birth.
These features include growth failure and a small and rather square
head. There is a flat facial profile, small nose, and somewhat
depressed nasal bridge; upward slanting of the eyes; small, low-set,
and malformed ears; and a large, protruding tongue. The child's hands
usually are short and stubby, with fingers that curl inward, and there
usually is only a single palmar crease (simian crease).
13. A 41-year-old woman has made the recent decision to start a
family and is eager to undergo testing to mitigate the possibility of
having a child with Down syndrome. Which of the following tests is
most likely to provide the data the woman seeks?
A) Genetic testing of the woman
B) Genetic testing of the woman and the father
C) Prenatal blood tests
D) Ultrasonography
Ans: C
Feedback:
Down syndrome is a result of chromosomal abnormality and
is not a single-gene disorder. As a result, genetic testing of the mother
and/or father is not relevant. Ultrasonography does not have
predicative value for Down syndrome, but blood tests such as -
fetoprotein, human chorionic gonadotropin (HCG), unconjugated
estriol, inhibin A, and pregnancy-associated plasma protein A have
helped ascertain the risks.
14. Aneuploidy of the X chromosome can result in a monosomy
or polysomy disorder. The clinical manifestations of a female with
monosomy X include: Select all that apply.
A) A short-stature female individual
B) Difficulty with fine motor skills
C) Large heavy breasts
D) Early-onset (age 8) puberty
E) Nonpitting lymphedema of the feet
Ans: A, B, E
Feedback:
Turner syndrome produces a female individual who is short,
has no secondary sex characteristics, has normal intelligence, and fails
to go through puberty due to an absence of ovaries. Polysomy X is a
XXY male. XXY males have tall slim stature with breast enlargement,
lack ofsperm, and normal intelligence. They may have problems with
visuospatial organization (driving a car, working math problems,
psychomotor skills, etc.). There are variations in the syndrome, with
abnormalities ranging from essentially none to webbing of the neck
with redundant skin folds and nonpitting lymphedema of the hands
and feet.
15. Genetic testing has revealed that a male infant has been born
with an extra X chromosome. What are the most likely implications of
this finding? The child:
A) Is unlikely to survive infancy
B) Islikely to have no manifestations of this chromosomal
abnormality
C) Will have significant neurological and cognitive defects
D) Will be unable to reproduce
Ans: B
Feedback:
An extra X chromosome is associated with Klinefelter
syndrome, but a majority of XXY males do not exhibit visible effects of
this chromosomal abnormality.
16. Although bacterial toxins vary in their activity and effects on
host cells, a small amount of gram-negative bacteria endotoxin:
A) Isreleased during cell growth
B) Inactivates key cellular functions
C) Uses protein to activate enzymes
D) In the cell wall activates inflammation
Ans: D
Feedback:
Endotoxins differfrom exotoxinsin several ways. Endotoxins
are found in the cell wall lipids of gram-negative bacteria and are
potent activators of life-threatening systemic responses such as acute
inflammation with clotting and hypotension. Exotoxins contain
protein, are released during cell growth, inactivate key cell functions,
and have enzymatic activity.
17. A 9-month-old infant has been diagnosed with botulism after
he was fed honey. The child's mother was prompted to seek care
because of this child's sudden onset of neuromuscular deficits, which
were later attributed to the release of substances by Clostridium
botulinum. Which virulence factor contributed to this child's illness?
A) Endotoxins
B) Adhesion factors
C) Exotoxins
D) Evasive factors
Ans: C
Feedback:
Exotoxins are proteinsreleased from the bacterial cell during
growth, as in the case of botulism poisoning. Adhesion factors, evasive
factors, and endotoxins are not evident in this release of botulinum
toxin.
18. While explaining evasive factors by microbes to evade
various components of the host'simmune system,the instructor uses
which of the following examples?
A) H. Pylori being able to survive in an acidic environment
B) Enzymes capable of destroying cell membranes
C) S. aureus ability to immobilize IgG
D) An infectious agent's ability to produce toxins
Ans: A
Feedback:
A number of factors produced by microorganisms enhance
virulence by evading various components of the host's immune
system. H. pylori, the infectious cause of gastritis and gastric ulcers,
produces a urease enzyme on its outer cell wall. The urease converts
gastric urea into ammonia, thus neutralizing the acidic environment of
the stomach and allowing the organism to survive in this hostile
environment. Infectious agents also produce invasive factors that
facilitate the penetration of anatomic barriers and host tissue. Most
invasive factors are enzymes capable of destroying cell membranes
(e.g., phospholipases), connective tissue (e.g., elastases, collagenases),
intercellular matrices (e.g., hyaluronidase), and structural protein
complexes (e.g., proteases). The effects of the pathogen's invasive
factors and toxins, combined with the antimicrobial and inflammatory
substances released by host cells, mediate the tissue damage and
pathophysiology of infectious diseases.
19. A client with a long-standing diagnosis of Crohn disease has
developed a perianal abscess. Which of the following treatments will
this client most likely require?
A) Antiviraltherapy
B) Antibiotic therapy
C) Surgical draining
D) Pressure dressing
Ans: C
Feedback:
Although antibiotics are likely to form a component of this
client's treatment, abscesses most often require surgical draining. A
pressure dressing or the use of antivirals is likely unnecessary.
20. In the usual course (stages) after a pathogen has entered the
host body, the stage when the host initially develops the appearance
of signs/symptoms like a mild fever and body aches is:
A) Incubation
B) Prodromal
C) Acute
D) Convalescence
Ans: B
Feedback:
The prodromalstage followsinoculation (the initialstage)
and is identified by the initial onset ofsymptoms in the host. Tissue
inflammation and damage is evident during the acute (3rd) stage.
Pathogen elimination and containment are characteristics of the
convalescent (4th) period, which follows the acute stage.
21. A client who lives with angina pectoris has taken a sublingual
dose of nitroglycerin to treat the chest pain he experiences while
mowing his lawn. This drug facilitatesrelease of nitric oxide, which will
have what physiologic effect?
A) Smooth muscle relaxation of vessels
B) Decreased heart rate and increased stroke volume
C) Increased preload
D) Reduction of cardiac refractory periods
Ans: A
Feedback:
Nitroglycerin produces its effects by releasing nitric oxide in
vascularsmooth muscle of the target tissues, resulting in relaxation of
this muscle and increased blood flow. This drug does not decrease
heartrate. Because it vasodilates, it decreases preload. Nitroglycerine
does not affect cardiac refractory periods.
22. Following a kitchen accident with a knife, the client's cut has
experienced a decrease in the amount of bleeding and has developed a
clot. The nurse knows this is primarily a result of humoral control of
blood flow with the release of:
A) Histamine
B) Bradykinin
C) Serotonin
D) Prostaglandin E2
Ans: C
Feedback:
Serotonin release causes vasoconstriction of blood vessels
and plays a major role in control of bleeding. Histamine, bradykinin,
and prostaglandin E2 cause vasodilation of blood vessels.
23. A client has had a myocardial infarction (MI) that damaged
the right atrium, which has interfered with the SA node. The
compensatory mechanism, the AV node, becomesthe pacemaker of
the heart and beats how many times/minute?
A) 10 to 20 beats/minute
B) 21 to 30 beats/minute
C) 45 to 50 beats/minute
D) 55 to 60 beats/minute
Ans: C
Feedback:
The AV nodal fibers, when not stimulated, discharge at an
intrinsic rate of 45 to 50 times a minute, and the Purkinje fibers
discharge 15 to 40 times/minute. The SA node hasthe fastest intrinsic
rate of firing (60–100 beats/minute) and normally functions as the
pacemaker of the heart. Should the SA node fail to discharge, the AV
node can assume the pacemaker function of the heart, and the
Purkinje system can assume the pacemaker function of the ventricles
should the AV junction fail to conduct impulses from the atria to the
ventricles.
24. A client asks why he has not had major heart damage since
his cardiac catheterization revealed he has 98% blockage of the right
coronary artery. The nurse's best response is:
A) “You must have been taking a blood thinner for a long time.”
B) “You have small channels between some of your arteries, so
you can get blood from a patent artery to one severely blocked.”
C) “You are just a lucky person since most people would have
had a massive heart attack by now.”
D) “With this amount of blockage, your red blood cells get
through the vessel one-by-one and supply oxygen to the muscle.”
Ans: B
Feedback:
Collateral circulation is a mechanism for the long-term
regulation of local blood flow. In the heart, anastomotic channels exist
between some of the smaller arteries. These channels permit
perfusion of an area by more than one artery. When one artery
becomes occluded, these anastomotic channels increase in size,
allowing blood from a patent artery to perfuse the area supplied by
the occluded vessel. For example, persons with extensive obstruction
of a coronary blood vessel may rely on collateral circulation to meet
the oxygen needs of the myocardial tissue normally supplied by that
vessel. There is no indication that the client is on a blood thinner.
25. The parasympathetic nervous system causes a slowing of the
heart rate by increasing:
A) Norepinephrine
B) Vessel constriction
C) Cardioinhibitory center
D) Smooth muscle tone
Ans: C
Feedback:
The medullary cardiovascular neurons are grouped into three
distinct pools that lead to sympathetic innervation of the heart and
blood vessels and parasympathetic innervation of the heart. The
cardioinhibitory center controls parasympathetic-mediated slowing of
heart rate. The parasympathetic system has little or no control over
blood vessels (constriction, tone). Norepinephrine is the main
neurotransmitter for sympathetic neurons.
26. The shortness of breath and cyanosis that occur in clients
experiencing acute heart failure syndrome are primarily caused by:
Select all that apply.
A) Accumulation of fluid in the alveoli and airways
B) Lung stiffness
C) Worsening renal failure
D) Myocardial muscle necrosis
E) Impaired gas exchange
Ans: A, B, E
Feedback:
Acute pulmonary edema is the most dramatic symptom of
AHFS. It is a life-threatening condition in which capillary fluid moves
into the alveoli. The accumulated fluid in the alveoli and airways
causes lung stiffness, makes lung expansion more difficult, and impairs
the gas exchange function of the lung. With the decreased ability of
the lungs to oxygenate the blood, the hemoglobin leaves the
pulmonary circulation without being fully oxygenated, resulting in
shortness of breath and cyanosis. Worsening renal failure and MI may
cause volume overload but are more likely secondary causes of chronic
heart failure.
27. While in the ICU, a client's status changes. The health care
providers suspect heart failure. Which of the following diagnostic
procedures would give the staff information about pulmonary capillary
pressures, which will lead to the most appropriate interventions?
A) Echocardiography
B) Radionuclide ventriculography
C) Cardiac magnetic resonance imaging
D) Hemodynamic monitoring
Ans: D
Feedback:
Invasive hemodynamic monitoring may be used for
assessment in acute, life-threatening episodes of heart failure. These
monitoring methods include central venous pressure (CVP), pulmonary
artery pressure monitoring, measurements of cardiac output, and
intra-arterial measurements of blood pressure. Echocardiography plays
a key role in assessing ejection fraction, right and left ventricular wall,
wall thickness, ventricular chamber size, valve function, heart defects,
and pericardial disease. Radionuclide ventriculography is
recommended if there is reason to suspect coronary artery disease or
ischemia as the underlying cause for heart failure. Cardiac magnetic
resonance imaging and cardiac computed tomography are used to
document ejection fraction, ventricular preload, and regional wall
motion.
28. A nurse is performing client health education with a 68-yearold man who has recently been diagnosed with heart failure. Which of
the following statements demonstrates an accurate understanding of
his new diagnosis?
A) “I'll be sure to take my beta blocker whenever I feelshort of
breath.”
B) “I'm going to avoid as much physical activity as I can so that I
preserve my strength.”
C) “I know it's healthy to drink a lot of water, and I'm going to
make sure I do this from now on.”
D) “I'm trying to think of ways that I can cut down the amount
of salt that I usually eat.”
Ans: D
Feedback:
Salt and fluid restrictions are indicated for most clients with
heart failure (HF). Beta blockers do not address shortness of breath,
and cardiac medications are not normally taken in response to acute
symptoms. Clients should be encouraged to maintain, and increase,
physical activity within the limits of their condition.
29. A client with a diagnosis of heart failure has returned from a
visit with his primary care provider with a prescription for a change in
his daily medication regimen. Which of the following drugs is likely to
improve the client's cardiac function by increasing the force and
strength of ventricular contractions?
A) A -adrenergic blocker
B) A diuretic
C) A cardiac glycoside
D) An ACE inhibitor
Ans: C
Feedback:
Cardiac glycosides improve cardiac function by increasing the
force and strength of ventricular contractions. -Adrenergic blockers
decrease left ventricular dysfunction associated with activation of the
sympathetic nervous system. ACE inhibitors block the conversion of
angiotensin I to II, whereas diuretics promote the excretion of fluid.
30. A client awaiting a heart transplant is experiencing
decompensation of her left ventricle that will not respond to
medications. The physicians suggest placing the client on a ventricular
assist device (VAD). The client asks what this equipment will do. The
health care providers respond:
A) “Pull your blood from the right side of the heart and run it
through a machine to oxygenate it better, and then return it to your
body.”
B) “Measure the pressures inside your heart continuously to
asses pumping ability of your left ventricle.”
C) “Have a probe at the end of a catheter to obtain
thermodilution measures,so cardiac output can be calculated.”
D) “This device will decrease the workload of the myocardium
while maintaining cardiac output and systemic arterial pressure.”
Ans: D
Feedback:
Refractory heart failure reflects deterioration in cardiac
function that is unresponsive to medical or surgical interventions.
Ventricular assist devices (VADs) are mechanical pumps used to
support ventricular function. VADs are used to decrease the workload
of the myocardium while maintaining cardiac output and systemic
arterial pressure. This decreases the workload on the ventricle and
allows it to rest and recover. The rest of the distractors relate to the
monitoring in an ICU of cardiac functioning. Invasive hemodynamic
monitoring may be used for assessment in acute, life-threatening
episodes of heart failure. With the balloon inflated, the catheter
monitors pulmonary capillary pressures (i.e., pulmonary capillary
wedge pressure or pulmonary artery occlusion pressure), which reflect
pressures from the left ventricle. The pulmonary capillary pressures
provide a means of assessing the pumping ability of the left ventricle.
One type of pulmonary artery catheter is equipped with a thermistor
probe to obtain thermodilution measurements of cardiac output.
31. A car accident client is admitted with a chest tube following
pneumothorax. He also has an elevated blood alcohol level. When the
nurse enters his room,she notes the client is dyspneic,short of breath,
and holding his chest tube in his hand. When the nurse pulls the linens
back, she finds a “sucking” chest wound. After calling a “code blue,”
the next priority intervention would be to:
A) Place the client's meal napkin over the wound
B) Observe and wait for the code blue team to bring equipment
C) Try to calm the patient down by maintaining therapeutic
communication
D) Apply a Vaseline gauze (airtight) dressing over the insertion
site
Ans: D
Feedback:
The client has a medical emergency. Sucking chest wounds,
which allow air to pass in and out of the chest cavity,should be treated
by promptly covering the area with an airtight covering. Chest tubes
are inserted as soon as possible. The other interventions will not help
minimize the amount of air entering the pleural space.
32. A client with a history of heart failure and COPD (caused by
60 pack/year smoking) presents to the clinic with the following
complaints: auscultation of breath sounds reveal absent/diminished
breath sounds in the right lower lobe. Which other manifestations lead
the health care provider to suspect the client may have developed
atelectasis? Select all that apply.
A) Respiratory rate—32; pulse rate—122 beats/minute.
B) “Having a hard time catching my breath.”
C) “Seemslike I'm not making much water (decreased urine
production).”
D) Using accessory muscles to help him breathe.
E) Copious amounts of thick, green sputum.
Ans: A, B, D
Feedback:
Atelectasis is caused most commonly by airway obstruction
rather than a vascular obstruction. The clinical manifestations of
atelectasis include tachypnea (respiratory rate of 32), tachycardia
(pulse rate of 122) dyspnea (hard time catching breath), cyanosis, signs
of hypoxemia, diminished chest expansion, absence of breath sounds,
and intercostal retractions (use of accessory muscles). Both chest
expansion and breath sounds are decreased on the affected side.
There may be intercostalretraction (pulling in of the intercostalspaces)
over the involved area during inspiration. Urine production is not
related to atelectasis. Copious green sputum is associated with
infection.
33. A client has just been admitted to the postsurgical unit
following a below-the-knee amputation. Which of the following
measuresshould her care team prioritize to prevent atelectasis during
the client's immediate recovery?
A) Bedrest and supplementary oxygen by nasal cannula
B) Administration of bronchodilators by nebulizer
C) Deep-breathing exercises and early mobilization
D) Adequate hydration and a high-humidity environment
Ans: C
Feedback:
Coughing and deep breathing and early ambulation decrease
the likelihood of atelectasis developing in surgical clients; bedrest
should be avoided when possible. Oxygen, bronchodilators, hydration,
and high humidity do not prevent atelectasis.
34. Which of the following is most likely to precipitate an
asthmatic attack in a child with a diagnosis of extrinsic, or atopic,
asthma?
A) Pet dander
B) Cold weather
C) Stress
D) Respiratory tractinfections
Ans: A
Feedback:
Extrinsic or atopic asthma is typically initiated by a type I
hypersensitivity reaction induced by exposure to an extrinsic antigen
or allergen such as pet dander. Intrinsic or nonatopic asthma triggers
include respiratory tract infections, exercise, hyperventilation, cold air,
drugs and chemicals, hormonal changes and emotional upsets,
airborne pollutants, and gastroesophageal reflux.
35. Which of the following manifestationstypically accompanies
an asthmatic attack?
A) Decreased residual volume
B) Decreased pulmonary arterial pressure
C) Prolonged inspiration
D) Hyperinflation of the lungs
Ans: D
Feedback:
During a prolonged attack, air becomes trapped behind the
occluded and narrowed airways, causing hyperinflation of the lungs.
This produces an increase in the residual volume of the lungs.
Pulmonary arterial pressure tends to increase and expiration becomes
prolonged.
36. A client has been recently undergone diagnostic testing for
possible Berger disease. The nurse caring for this client would
anticipate the primary clinical manifestations include which of the
following? Select all that apply.
A) Gross hematuria
B) Recent upper respiratory infection
C) Elevated ketone levelsin the urine
D) Fever, chills, and general body aches
Ans: A, B, D
Feedback:
Early in the disease, many people with the disorder have no
obvious symptoms, and the disorder is discovered during screening or
examination for another condition. In others, the disorder presents
with gross hematuria that is preceded by upper respiratory tract
infection, GI tractsymptoms, or flulike illness. The hematuria lasts 2 to
6 days. Elevated ketones are usually associated with acidosis, fasting,
high-protein diet, or diabetes to name a few.
37. A 43-year-old female has recently been diagnosed with
systemic lupus erythematosus (SLE) glomerulonephritis. She has
presented to the out-client department to have a renal biopsy.
Knowing the usual treatment options, the nurse should anticipate
educating the client (who has a positive biopsy result) on which of the
following medications being prescribed? Select all that apply.
A) Lasix, a diuretic
B) Prednisone, a corticosteroid
C) Captopril, an ACE inhibitor
D) Ampicillin, an antibiotic
Ans: B, C
Feedback:
Treatment depends on the extent of glomerular involvement.
Oral corticosteroids and angiotensin-converting enzyme (ACE)
inhibitors are the mainstays of treatment. Diuretics and antibiotics are
not part of the treatment protocol.
38. The most recent assessment of a client with a diagnosis of
type 1 diabetes indicates a heightened risk of diabetic nephropathy.
Which of the following assessment findings is most suggestive of this
increased risk?
A) Microalbuminuria
B) Hematuria
C) Orthostatic hypotension
D) Diabetic retinopathy
Ans: A
Feedback:
The increased glomerular filtration rate (GFR)that occursin
persons with early alterations in renal function is associated with
microalbuminuria, which is an important predictor of future diabetic
nephropathies. Hematuria is not directly suggestive of diabetic
nephropathy, although it is a highly significant assessment finding.
Orthostatic hypotension and diabetic retinopathy are not direct
indicators of diabetic nephropathy.
39. Which of the following diagnostic and assessment results
support the diagnosis of chronic pyelonephritis? Select allthat apply.
A) Polyuria (excess urine output)
B) Nocturia (voiding at night)
C) Bilateral flank pain
D) Blood pressure 140/92
E) Severe pain in upper outer quadrant of the abdomen
Ans: A, B
Feedback:
The symptoms of chronic pyelonephritis often include a
history of recurrent episodes of UTI or acute pyelonephritis. Loss of
tubular function and the ability to concentrate urine give rise to
polyuria and nocturia, and mild proteinuria is common. Severe
hypertension often is a contributing factor in the progress of the
disease. A BP of 140/92 is not considered “severe” hypertension. Flank
and upper outer quadrant pain is usually associated with kidney
stones.
40. An elderly female client has been hospitalized for the
treatment of acute pyelonephritis. Which of the following
characteristics of the client is most likely implicated in the etiology of
her current health problem? The client:
A) Has been diagnosed with type 2 diabetes several years
earlier
B) Takes a diuretic and an ACE inhibitor each day for the
treatment of hypertension
C) Recently had a urinary tractinfection
D) Has peripheral vascular disease
Ans: C
Feedback:
There are two routes by which bacteria can gain access to the
kidney: ascending infection from the lower urinary tract and through
the bloodstream. Ascending infection from the lower urinary tract is
the most important and common route by which bacteria reach the
kidney, resulting in acute pyelonephritis. Diabetes, hypertension
controlled by a diuretic and an ACE inhibitor, and peripheral vascular
disease are not associated with acute pyelonephritis.
41. A client is experiencing bladder hyperactivity. The nurse
should be prepared to educate the client about which of the following
medications that may be injected to help decrease the bladder
hyperactivity?
A) Capsaicin, a specific C-fiber afferent neurotoxin
B) Botulinum toxin type A
C) Oxybutynin, an antimuscarinic agent
D) Urecholine, a cholinergic agonist
Ans: A
Feedback:
Intravesical injection of medications, such as capsaicin and
resiniferatoxin, that are specific C-fiber afferent neurotoxins may be
used to decrease bladder hyperactivity. Botulinum toxin type A is used
to produce paralysis of striated muscles of the externalsphincter.
Oxybutynin, an antimuscarinic agent, will decrease detrusor muscle
tone. Urecholine, a cholinergic agonist, stimulates parasympathetic
receptors to increase bladder tone.
42. A female client asks, “Why do I leak urine every time I cough
or sneeze?” The health care worker's response is based on which
physiologic principle?
A) Involuntary bladder continence during filling
B) A pressure difference between the urethra and bladder
C) When intravesical pressure exceeds maximal urethral closure
pressure
D) A decrease in bladder distensibility
Ans: C
Feedback:
Stress incontinence represents the involuntary loss of urine
that occurs when, in the absence of detrusor muscle action, the
intravesical pressure exceeds the maximum urethral closure pressure.
Stressincontinence, which is a common problem in women of all ages,
occurs as the result of weakness or disruption of pelvic floor muscles,
leading to poorsupport of the vesicourethralsphincters. Except during
the act of micturition, intraurethral pressure is normally greater than
intravesical pressure. Urge incontinence and overactive bladder are
associated with urgency caused by bladder infection or CNS or
myogenic mechanisms. Overflow incontinence is an involuntary loss of
urine that occurs when intravesical pressure exceeds the maximal
urethral pressure because of bladder distention in the absence of
detrusor activity.
43. The nurse is scheduled to teach a client experiencing urinary
incontinence about Kegel exercises. Which of the following descriptors
should the nurse include in this education?
A) “Drink at least two glasses of water and then try to hold it for
at least 3 hours before going to the bathroom.”
B) “Contract and relax the pelvic floor muscles at least 10 times
every hour while awake.”
C) “After you have emptied your bladder, continue sitting on the
commode and try to forcefully expel more urine.”
D) “Try to start and stop urination while sitting in a bathtub full
of warm soapy water.”
Ans: B
Feedback:
Exercises for the pelvic muscles or Kegel exercises involve
repetitive contraction and relaxation of the pelvic floor muscles and
are an essential component of client-dependent behavioral
interventions. None of the other distractors are examples of Kegel
exercises.
44. An elderly client who experiences chronic pain takes opioid
analgesics on a regular basis, a practice that has resulted in frequent
constipation and occasional bowel obstructions. Which of the
following problems may directly result from these gastrointestinal
disorders?
A) Urinary tractinfections
B) Overflow urinary incontinence
C) Bladder cancer
D) Neurogenic bladder
Ans: B
Feedback:
Fecal impaction occurs when a large bolus of stool forms in
the rectum, which can push against the urethra causing obstruction
that results in overflow incontinence. This does not constitute a risk
factor for bladder cancer or neurogenic bladder, and although a
urinary tract infection (UTI) may result, thisis an indirect consequence
of the bowel obstruction.
45. Many factors contribute to the incontinence thatis common
among the elderly. A major factor is increased:
A) Detrusor muscle function
B) Intake of liquids and water
C) Urethral closing pressure
D) Use of multiple medications
Ans: D
Feedback:
Use of multiple medications for other health problems can
affect bladder function, especially diuretics. Drugs such as hypnotics,
tranquilizers, and sedatives can interfere with the conscious inhibition
of voiding, leading to urge incontinence. Detrusor muscle function and
urethral closing pressure are decreased in the elderly, causing
incontinence. Decreased fluid and water intake causes problems of
bowel impaction and urinary tract infection.
46. A major factor in the development of hepatic
encephalopathy is:
A) Hypersplenism
B) High sodium level
C) Neurotoxin accumulation
D) Steroid hormone deficiency
Ans: C
Feedback:
Although the cause of hepatic encephalopathy is unknown,
the accumulation of neurotoxins, which appear in the blood because
the liver has lost its detoxifying capacity, is believed to be a factor. The
liver metabolizesthe steroid hormones; therefore, these hormones are
often elevated in persons with liver failure and cause feminization
(rather than encephalopathy) of male clients. Hypersplenism
associated with liver failure is a factor in the development of anemia,
thrombocytopenia, and leukopenia. Although the mechanisms
responsible for the development of ascites are not completely
understood, several factors seem to contribute to fluid accumulation,
including salt and water retention by the kidney and increase in
capillary pressure due to portal hypertension and obstruction of
venous flow through the liver.
47. Hepatocellular cancer usually has a poor prognosis due in
part to which of the following factors?
A) Surgical options do not exist because removal of all or part of
the liver is a threat to health.
B) Liver cancer typically metastasizes at a much earlierstage
than other cancers.
C) Liver tumors are poorly differentiated due to the low density
of hepatic tissue.
D) The nonspecific symptomatology of liver cancer leads to a
diagnosis at a late stage.
Ans: D
Feedback:
Primary cancers of the liver are often far advanced at the
time of diagnosis. This is partly due to the fact that the manifestations
are often insidious in onset and masked by those related to cirrhosis or
chronic hepatitis. Surgical options exist, and metastasis does not occur
earlier than in other types of cancer, although the liver is a common
site of secondary cancer. Liver tumors do not lack differentiation.
48. An ultrasound (US) of a client with intermittent pain reveals
gallbladder sludge. Which of the following client history items are
likely factors in the US result? Select all that apply.
A) Had lap band surgery 2 years ago and lost 100 pounds
B) Recent pregnancy with a 6-month-old child at home
C) Current prescription for a medicine to lower cholesterol
D) A runner training for a marathon
E) Worksin surgery with long periods ofstanding in one place
Ans: A, B, C
Feedback:
Three factors contribute to the formation of gallstones:
abnormalities in the composition of bile, stasis of bile (rather than
rapid elimination), and inflammation of the gallbladder. The formation
of cholesterol stones is associated with obesity and occurs more
frequently in women, especially women who have had multiple
pregnancies or who are taking oral contraceptives. All of these factors
cause the liver to excrete more cholesterol into the bile. Estrogen
reduces the synthesis of bile acid in women. Gallbladder sludge
(thickened gallbladder mucoprotein with tiny trapped cholesterol
crystals) is thought to be a precursor of gallstones. Sludge frequently
occurs with pregnancy, starvation, and rapid weight loss. Drugs that
lowerserum cholesterol levels,such as clofibrate, also cause increased
cholesterol excretion into the bile.
49. Which of the following factorsis moststrongly associated
with the pathogenesis of gallstones?
A) Excess serum ammonia and urea levels
B) Portal hypertension
C) Abnormalities orstasis of bile
D) High-cholesterol diet
Ans: C
Feedback:
Three factors contribute to the formation of gallstones:
abnormalities in the composition of bile, stasis of bile, and
inflammation of the gallbladder. Portal hypertension, a highcholesterol diet, and excess ammonia and/or urea are not causative
factors of cholelithiasis.
50. Which of the following signs and symptoms is most
suggestive of acute cholecystitis?
A) Upper right quadrant or epigastric pain
B) Fever and sudden abdominal distention
C) Appearance of undigested fat in feces
D) Nausea resulting in greenish vomitus
Ans: A
Feedback:
Persons with acute cholecystitis usually experience an acute
onset of upper right quadrant or epigastric pain. Nausea and vomiting
are also common, although these are not specific to cholecystitis.
Abdominal distention and steatorrhea are not key signs of acute
cholecystitis.
51. The signs and symptoms of abrupt cessation of
pharmacologic glucocorticoids closely resemble those of:
A) Addison disease
B) Cushing disease
C) Cushing syndrome
D) Graves disease
Ans: A
Feedback:
Although the etiology differs, the adrenal cortical
insufficiency resulting from the abrupt cessation of glucocorticoidsis
nearly identical to Addison disease in terms of physiologic effects.
52. Which of the following pathophysiologic phenomena may
result in a diagnosis of Cushing disease?
A) Hypopituitarism
B) Excess ACTH production by a pituitary tumor
C) Autoimmune destruction of the adrenal cortex
D) Malfunction of the HPA system
Ans: B
Feedback:
Three important forms of Cushing syndrome result from
excess glucocorticoid production by the body. One is a pituitary form,
which results from excessive production of ACTH by a tumor of the
pituitary gland. Hypopituitarism and destruction of the adrenal cortex
are associated with Addison disease. Disruption of the HPA system is
not implicated in the etiology of Cushing disease.
53. A lung cancer client with small cell carcinoma may secrete an
excess of which hormone causing an ectopic form of Cushing syndrome
due to a nonpituitary tumor?
A) GH
B) TSH
C) DHEA
D) ACTH
Ans: D
Feedback:
The third form (of Cushing syndrome) is ectopic Cushing
syndrome, caused by a nonpituitary ACTH-secreting tumor. Certain
extra pituitary malignant tumors such as small cell carcinoma of the
lung may secrete ACTH or, rarely, CRH and produce Cushing syndrome.
The adrenalsex hormone dehydroepiandrosterone (DHEA) contributes
to the pubertal growth of body hair, particularly pubic and axillary hair
in women. Thyroid-stimulating hormone (TSH) levels are used to
differentiate between primary and secondary thyroid disorders.
Although secretion of growth hormone (GH) has diurnal variations
over a 24-hour period, with nocturnal sleep bursts occurring 1 to 4
hours after onset of sleep, it is unrelated to ACTH and/or CRH
secretion.
54. The iatrogenic form of Cushing syndrome is caused by:
A) Long-term cortisone therapy
B) Pituitary tumorsecreting ACTH
C) Benign or malignant adrenal tumor
D) Ectopic ACTH-secreting lung tumor
Ans: A
Feedback:
Three important forms of Cushing syndrome result from
excess glucocorticoid production by the body. One is a pituitary form,
which results from excessive production of ACTH by a tumor of the
pituitary gland, called Cushing disease. The second form is the adrenal
form, caused by a benign or malignant adrenal tumor. The third form is
ectopic Cushing syndrome, caused by a nonpituitary ACTH-secreting
tumor, often carcinoma of the lung. Iatrogenic Cushing syndrome
resultsfrom long-term therapy with one of the potent pharmacologic
preparations of glucocorticoids.
55. Which of the following clinical manifestations would support
57. A client with chronic low back pain presents to the clinic. In
addition to a detailed pain assessment, which of the following
questions would be appropriate to ask? Select all that apply.
A) “Do you have trouble making water?”
the medical diagnosis of Cushing syndrome? Select all that apply. B) “Can you financially afford your medicine?”
A) Excessive facial hair growth C) “What kind ofstressors are you experiencing?”
B) Muscle hypertrophy D) “Do you consider yourself a good driver?”
C) Blood glucose level in 200 mg/dL range E) “Are you having trouble sleeping?”
D) “Buffalo hump” on back Ans: B, C, E
E) Blood pressure reading less than 90/70 Feedback:
Ans: A, C, D Unlike acute pain thatserves as a warning system, persistent
Feedback:
The major manifestations of Cushing syndrome represent an
exaggeration of the many actions of cortisol. There is muscle
weakness, and the extremities are thin. Derangements in glucose
metabolism are found in approximately 75% of clients, with clinically
overt diabetes mellitus occurring in approximately 20% of clients. The
glucocorticoids possess mineralocorticoid properties; this causes fluid
retention and hypertension resulting from sodium retention, water
retention, and hypervolemia. An increase in androgen levels causes
hirsutism. Altered fat metabolism causes a peculiar deposition of fat
characterized by a protruding abdomen; subclavicular fat pads or
“buffalo hump” on the back; and a round, plethoric “moon face.”
56. When lecturing about heart attacks(myocardial infarctions),
the instructor will emphasize the client may present with: Select all
that apply.
A) Substernal chest pain
B) Neck pain
C) Umbilicus pain
D) Deep, right-sided abdominal pain
E) Pain that radiatesto the left arm
Ans: A, B, E
Feedback:
Referred pain is perceived at a site different from the location
of its point of origin but innervated by the same spinal segment. The
sites of referred pain are determined embryologically with the
development of visceral and somatic structures that share the same
site for entry of sensory information into the central nervous system
(CNS) and then move to more distant locations. Pain that originates in
the abdominal or thoracic viscera is diffuse and poorly localized and is
often perceived at a site far removed from the affected area. For
example, the pain associated with myocardial infarction commonly is
referred to the left arm, neck, and chest, which may delay diagnosis
and treatment of a potentially life-threatening condition.
chronic pain usually serves no useful function. To the contrary, it
imposes physiologic, psychological, interpersonal, and economic
stresses and may exhaust a person's resources. It is often associated
with loss of appetite, sleep disturbances, and depression, which
commonly is relieved once the pain is removed. Trouble urinating
(dysuria) is usually not associated with chronic pain syndrome (unless
this is a preexisting condition like BPH). A person's ability to drive is
not a priority question asked of a client with chronic pain.
58. A client with a diagnosis of lung cancer has developed bone
metastases resulting in severe and protracted pain. Which of the
following assessment components should the nurse prioritize when
assessing the client's pain?
A) The appearance of grimacing, guarding, or wincing
B) The presence of changes in vital signs that correspond to pain
C) The client'ssubjective report of the character and severity of
pain
D) The results of a detailed neurologic assessment
Ans: C
Feedback:
Although objective signs of pain may or may not be evident,
the priority component of any pain assessment is the client's selfreport.
59. Which of the following interventions would be considered a
nonpharmacologic method of pain control? Select all that apply.
A) Distraction by knitting
B) Guided imagery
C) Biofeedback
D) OTC acetaminophen
Ans: A, B, C
Feedback:
A number of nonpharmacologic methods of pain control are
used in pain management. These include cognitive–behavioral
interventions (e.g., relaxation, distraction, imagery, and biofeedback),
physical agents (e.g., heat and cold), electroanalgesia (transcutaneous
electrical nerve stimulation [TENS]), and acupuncture. Even though
acetaminophen is an over-the-counter pain medication, it is still a
pharmacologic intervention.
60. A hospital client has been reluctant to accept morphine
sulfate despite visible signs of pain. Upon questioning, the client
reveals that he is afraid of becoming addicted to the drug. How can a
member of the care team best respond to the client's concern?
A) “You might become addicted, but there are excellent
resources available in the hospitalto deal with that development.”
B) “You should likely prioritize the control of your pain over any
fears of addiction that you have.”
C) “If you start needing higher dosesto control your pain, then
we'll address those concerns.”
D) “There's only a minute chance that you will become addicted
to these painkillers.”
Ans: D
Feedback:
Although long-term treatment with opioids can result in
opioid tolerance (i.e., increasingly greater drug dosages being needed
to achieve the same effect) and physical dependence, this should not
be confused with addiction. Long-term drug-seeking behavior israre in
persons who are treated with opioids only during the time that they
require pain relief.
61. Which of the following pathophysiologic processes occursin
cases of bacterial meningitis?
A) Infection in the cerebrospinal fluid causes vasoconstriction
and cerebral hypoxia.
B) Trauma introducesskin-borne pathogensto the
cerebrospinal fluid.
C) Infection in the cerebrospinal fluid causesspinal cord
compression and neurologic deficits.
D) Inflammation allows pathogens to crossinto the
cerebrospinal fluid.
Ans: D
Feedback:
In the pathophysiologic process of bacterial meningitis, the
bacterial organisms replicate and undergo lysis in the CSF, releasing
endotoxins or cell wall fragments. These substances initiate the release
of inflammatory mediators, which set off a complex sequence of
events permitting pathogens, neutrophils, and albumin to move across
the capillary wall into the CSF. Cerebral hypoxia does not result directly
from meningitis, and the causative pathogens are not introduced from
the skin nor is trauma an initiating event. Spinal cord compression is
not an expected consequence of meningitis.
62. Common manifestations of acute meningococcal meningitis,
a highly contagious and lethal form of meningitis, include:
A) Diplopia
B) Petechiae
C) Papilledema
D) Focal paralysis
Ans: B
Feedback:
Meningococcal meningitis causes a petechial rash with
palpable purpura in most people. The most common manifestations of
acute bacterial meningitis are fever and chills; headache; stiff neck
(nuchal rigidity) and back; abdominal and extremity pains; and nausea
and vomiting. Other signs include seizures, cranial nerve damage
(especially the eighth nerve, with resulting deafness), and focal
cerebral signs. General signs and symptoms of brain tumor include
headache, papilledema, nausea, vomiting, mental changes, visual
disturbances(e.g., diplopia), alterations in sensory and motor function,
and seizures. Like meningitis, encephalitis is characterized by fever,
headache, and nuchal rigidity, but more often clients also experience
neurologic disturbances, such as focal paralysis, lethargy,
disorientation, seizures, delirium, and coma.
63. A family brings a client to the emergency department with
increasing lethargy and disorientation. They think the client had a
seizure on the drive over to the hospital. The client has been sick with
a “cold virus” for the last few days. On admission, the clients'
temperature is 102°F. Which other clinical manifestations may lead to
the diagnosis of encephalitis?
A) Petechia over entire body
B) BP 100/72
C) Impaired neck flexion resulting from muscle spasm
D) Appearance of red-purple discolorations on the skin that do
not blanch on applying pressure
Ans: C
Feedback:
Like meningitis, encephalitis is characterized by fever,
headache, and nuchal rigidity (impaired neck flexion resulting from
muscle spasm), but more often clients also experience neurologic
disturbances,such aslethargy, disorientation,seizures, focal paralysis,
delirium, and coma. Meningococcal meningitis is characterized by a
petechial (petite hemorrhagic spots) rash with palpable purpura (red-
purple discolorations on the skin that do not blanch on applying
pressure) in most people. This BP is within normal range.
64. Which of the following individuals has the highest chance of
having a medulloblastoma?
A) An 88-year-old man who has begun displaying signs and
symptoms of increased ICP
B) A 60-year-old woman who issoon to begin radiation therapy
for the treatment of breast cancer
C) A 4-year-old child who has become uncoordinated in recent
months
D) A 68-year-old man who is a smoker and has a family history
of cancer
Ans: C
Feedback:
Tumors of neuronal origin (e.g., medulloblastoma) usually
occur during infancy and childhood. This is due to the fact that a cell
must be capable ofreplication to undergo neoplastic transformation.
65. Following surgery for a large malignant brain tumor, the
nurse should anticipate discussing which further treatment option with
the family that may ensure that any remaining cancer cells will be
killed?
A) Chemotherapy
B) Immunotherapy
C) Gamma knife radiation
D) Stem cell transplant
Ans: C
Feedback:
Most malignant brain tumorsrespond to external irradiation.
Irradiation can increase longevity and sometimes can allay symptoms
when tumors recur. The treatment dose depends on the tumor's
histologic type, responsiveness to radiation, and anatomic site and on
the level of tolerance of the surrounding tissue. A newer technique
called gamma knife combines stereotactic localization of the tumor
with radiosurgery, allowing delivery of high-dose radiation to deep
tumors while sparing the surrounding brain.
66. Which of the following clients is at greatest risk for
developing balanitis xerotica obliterans?
A) A homosexual male with a monogamous partner
B) A client who has had their pituitary gland removed due to
cancer
C) A male who has an uncircumcised penis
D) A middle-aged male with history of chronic prostatitis
Ans: C
Feedback:
Balanitis xerotica obliterans is a chronic,sclerosing, atrophic
process of the glans penis that occurssolely in uncircumcised men. As
such, the uncircumcised state supersedes the influence of sexual
behavior, prostatitis, or hormonal effects of not having a pituitary
gland.
67. Which of the following clinical manifestations are
characteristic for clients with Peyronie disease? Select allthat apply.
A) Painful erection
B) Thick, yellow discharge from the penis
C) Presence of a hard mass on the tunica albuginea of the penis
D) Papillary lesions on penis filled with serous-colored fluid
E) Thick, nonretractable foreskin of uncircumcised male
Ans: A, C
Feedback:
Peyronie disease involves a localized and progressive fibrosis
of unknown origin that affects the tunica albuginea (i.e., the tough,
fibroussheath thatsurrounds the corpora cavernosa) of the penis. The
manifestations of Peyronie disease include painful erection, bent
erection, and the presence of a hard mass at the site of fibrosis.
Approximately two thirds of men complain of pain as a symptom.
Discharge and lesionsfrom the penisis usually caused from infections
or STDs. Thick, nonretractable foreskin of uncircumcised male is
associated with balanitis xe